As the King vs. Burwell ruling set the ACA exchanges in stone and news of potential payer consolidations hit the media, the individual insurance market looks to be center stage for the foreseeable future. Analysis by DRG's data team shows the rapidly growing individual market has become a competitive hotspot, where the top five payers offering individual HIX plans have secured over 30 percent of the market. The July 2015 enrollment shows Anthem, UnitedHealth Group and Aetna in the top 3, with Health Care Service Corporation and Humana fighting for control of 4th and 5th in a tight race.

Even with several national players holding the top spots in the exchanges, elsewhere the rankings have shifted from 2014 to 2015. Analysis based upon DRG's exchange estimations (developed from a multi-demographic regression and consumer behavior model) finds that while Anthem has remained the consistent leader throughout the game, other nationals such as Aetna and Humana have achieved more than 50 percent increases in enrollment since the exchanges opened. Even UnitedHealth Group, which for the most part laid out of the first exchange season, made a running leap onto to the podium, securing second place from 2014's Health Care Service Corporation. The market may be looking to change once again, if a merger is completed between Aetna and Humana, as their combined exchange enrollment could easily put them over 1 million members and holding the gold for the individual exchange market.

Though the nationals have held a firm spot on the main stage, the foundation of the ACA ensures that each individual state is a unique playing field. Florida's exchange is a prime example. Though DRG's premium analysis (based on those of an average 40 year old) found Florida Blue with the largest increases from the 2014 to 2015 open enrollment period, the independently owned Blues has managed to rely on heavy brand recognition in the state of Florida to move from third to first in the enrollment rankings. On the other hand, Aetna, Centene and Molina all dropped premium prices by over 10 percent and still were unable to edge out the local Blues presence.

As the shuffle of rankings continue to occur, payers are looking for strategies that target this more highly individual and price-aware group of consumers. A deeper examination of national trends from the 2014 to 2015 open enrollment seasons found that one prominent tactic has been product line differentiation. More and more payers are moving from a one-size-fits-all PPO approach towards a customizable, cost-saving HMO option for exchange members. For example, No. 2 Florida payer Aetna moved 60,000 exchange members to HMOs in 2015, and eliminated its PPO offerings in that sector.

With two exchange seasons on the books, insurers are starting to cement strategies for this previously low-priority consumer group. What remains to be seen is if the rankings will start to solidify for the 2016 open enrollment session, or if proposed premium changes will once again shake up the markets.

For more startling data and analysis of DRG's continued coverage in the world of individual Health Insurance Exchanges, check out the brand-new DRG Knows Lives interactive infographic at DRGKnowsLives.com.

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